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A Pediatric Perspective

Born Addicted

Published February 10, 2013 5:15 PM by Cecilia Cruse

This past week I was catching up with a dear friend and colleague who works the NICU in a busy urban acute care hospital.  Her role as an OT has shifted as she responds to a growing trend in the US: that the number of newborns showing symptoms of withdrawal from opioids including prescription pain killers like Vicodin and Oxycontin have tripled in the past decade.  Termed Neonatal Abstinence Syndrome (NAS) between 2000-2009 the incidence increased from 1.2 per 1000 live births to 3.39 according to a study published in  JAMA in May 2012. That's about 13, 539 infants overall or roughly 1 baby born per hour. Although there are often legitimate reasons the mother is taking these drugs during pregnancy (as part of pain management for certain types of cancer for example) in many cases the cause stems from maternal drug abuse.  These neonates can be, but are not always preemies, but they do have particular issues including extreme irritability (with a very distressed cry), increased rigidity and poor state regulation which can lead to problems with feeding/digestion, sleeping and normal growth and development.  The babies are often given small amounts of oral morphine or methadone as they are slowly weaned off the narcotics.  As an OT, my friend plays an important role during this transition by working with the babies and instructing their caregivers (both nursing and parents) with positioning, promoting self-regulation, improving oral motor skills and helping to increase/maintain good range of motion.  We both agreed her role is vital in the NICU, but what happens to these babies down the road after discharge?  In my brief amateur attempt at a literature review, I can't seem to find any longevity studies that indicate what outcomes/sequelae these babies have as they grow and develop. Do you work with any infant/toddlers and older that have been diagnosed with NAS?  What trends to you see in your practice with these children?  In the meantime, kudos to my friend who is working to make a difference, one baby at a time.

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